On 11 November 2016, US multinational Pfizer agreed to lower the price of its pneumonia vaccine to $9.30 per child for all humanitarian organisations ‘working in emergency settings’. Although short of the $5 per child Médecins sans Frontières’s (MSF) campaign A Fair Shot has been demanding for seven years, it is a significant reduction compared to the $204.30 per child MSF paid to vaccinate refugee children in Greece earlier this year. Pfizer’s capitulation followed a principled rejection by MSF of one million ‘free vaccines’ it was offered by Pfizer in October 2016. As Jason Cone, the US Executive Director of MSF explained in an open letter to Pfizer: ‘there’s no such thing as “free” vaccines’. Earlier, in September, British pharmaceutical GlaxoSmithKline (GSK) also agreed to lower the price of its pneumonia vaccine for humanitarian organisations to $9 per child. We salute MSF on this campaign milestone, but the generosity of Big Pharma is transient and its monopolistic, exploitative and criminal actions must be exposed and opposed. Charles Chinweizu reports.

Pneumonia

Pneumonia, a common respiratory illness, is the leading infectious cause of death (16%) among children under five, especially in Africa and Asia, killing over 920,000 children in 2015 (Unicef). Most were under two years old. The two most common causes of bacterial pneumonia are Streptococcus pneumoniae and Haemophilus influenzae type b (Hib). Invasive pneumococcal infections caused by S. pneumoniae include pneumonia, meningitis and blood poisoning. Childhood pneumonia is linked to poverty. But while children can be protected with simple medication and care, only one third of those affected receive the antibiotics they need. In addition, increasing antibiotic resistance by multidrug-resistant S. pneumoniae means preventing pneumonia via immunisation is essential to reduce child mortality, but global coverage of the pneumococcal conjugate vaccine (PCV) among children in 2015 was only 37%, mainly due to its high cost. Infections by S. pneumoniae are among the main vaccine-preventable diseases..

Pneumococcal conjugate vaccine

The Pneumococcal Polysaccharide Vaccine (PPSV) developed in 1976 contained 14 of the 92 different serogroups (strains) of S. pneumoniae. This evolved to the 23-strain version (PPSV-23) first approved for use in over 65s and high-risk adults in 1983. Unfortunately, PPSV-23 did not provide protection to the most vulnerable group – children under two years of age. Two vaccines – branded Prevnar 7 and Prevnar 13 – were later developed which were effective in doing so. Both were developed by Wyeth (acquired by Pfizer in 2009). Prevnar 7 earned Wyeth $2.4bn in sales in 2007, a major reason for the acquisition. Pfizer made $6.2bn in Prevnar 13 sales in 2015.

Synflorix is GSK’s 10-strain PCV version approved in the EU and 90 other countries, although not in the US. GSK has racked up over $3bn in sales of Synflorix so far.

Breaking the monopoly

As MSF point out, ‘free [vaccines] are not always better and come with numerous strings attached, including restrictions on which patient populations and what geographic areas are allowed to receive the benefits’. What MSF did not point out is that only Pfizer would decide what qualifies as an ‘emergency situation’, and who is or isn’t a ‘humanitarian organisation’. Only GSK and Pfizer manufacture the pneumonia vaccine and they have racked up over $36bn in sales on this one vaccine alone since 2002. It costs 68 times more to fully immunise a child with 12 vaccines in poor countries now than it did in 2001, and the expensive pneumonia vaccine accounts for much of that increase. Pfizer successfully sued South Korean company SK Chemicals for producing an analogue that violated its patent in 2015. Pfizer secretively charges different prices in different countries for Prevnar 13: $63.70 in Morocco, $67.30 in Tunisia, $58.40 in France and $136 in the US – pure profiteering.

Similarly, the human papilloma virus (HPV) vaccine, that protects women against cervical cancer, is only manufactured by GSK and Merck Sharp & Dohme (MSD). The rotavirus vaccine against diarrhoea (the second leading cause of childhood death worldwide) is only made by GSK and MSD. The new malaria vaccine is only made by GSK. The high price of the HPV vaccine ‘earns’ GSK and MSD returns 12-16 times the cost of manufacture. In 2015, both major and generic pharmaceutical companies (‘health technology’) were the most profitable industry in the world, ahead of banking or energy minerals sectors (Forbes.com, 23 September 2015). Meanwhile, research into better drugs for one of the world’s deadliest diseases, tuberculosis, is virtually non-existent, with more spent on marketing than on research and development.

Indian vaccine manufacturer Serum Institute plans to make a version of PCV in the next few years. India is a major manufacturer of generic drugs meant to be a cheaper alternative to expensive branded versions, as well as vaccines for aid organisations. 40% of generics sold in the US are Indian-manufactured. Both China and India’s pharmaceutical industries are under attack from the Big Pharma controlled-FDA, using ‘integrity, reliability and accuracy of data’ as a smokescreen intended to protect Big Pharma’s market share and profits. Six Indian drug makers have had their manufacturing sites blacklisted by the FDA; 39 facilities in India have lost clearance due to regulatory problems. In 2015, the EU banned 700 Indian-made generic drugs, citing doubts about the credibility of clinical trials (Financial Times, 9 September 2015).

Ever innovative, socialist Cuba has also produced a (yet to be approved) conjugate pneumonia vaccine, PCV7-TT – containing seven of the most frequent serotypes circulating in Cuba and worldwide. It underwent Phase I clinical trials in June-July 2012, and was shown to be as effective and as safe as other commercial PCVs. Vicente Verez, director of the Biomolecular Chemistry Center in Havana, says Cuba ‘has been working for many years [since 2008] on developing this vaccine’ (Granma, 16 October 2014). PCV7-TT is currently in Phases II-III clinical trials.